CLASS CSA, CLASS, DSA, HCS, TxHmL, CDA, and Local Authorities:

DADS is expanding utilization management and review activities for its Medicaid community entitlement and waiver programs, effective January 1, 2012. (Letter)

ADC, ALF, HCSSA, ICF/ID, and NF:

Beginning March 1, 2012, if the name of an applicant or associated person is listed in a health and human services agency record of adverse licensing, DADS may deny the person’s application for a license or renewal. (Letter)

Hospice, ICF/ID, and NF:

DADS clarified how to apply CMS S&C Letter 11-30-NH in the context of DADS’ current incident reporting requirements. An excerpt:

Here are some points of guidance with regard to applying the provisions of S&C 11-30-NH in the context of DADS’ current incident reporting requirements:

• Section 1150B requires reporting of “any reasonable suspicion of a crime” to at least one local law enforcement agency of jurisdiction and to DADS. Reports to DADS (and the Department of Family and Protective Services, if appropriate) must also be made in accordance with current reporting guidelines as outlined in Provider Letter 06-12 and 40 TAC §97.249 (Hospice), Provider Letter 06-43 (NF), Provider Letter 09-02 (non-licensed ICF/ID) and Provider Letter 10-24 (licensed ICF/ID).

• Facilities, per page 3 of S&C 11-30, should coordinate with local law enforcement entities to determine what actions are considered crimes within their political jurisdiction. In the event more than one local law enforcement entity may have jurisdiction, such as a local police or sheriff’s department, DADS recommends facilities confirm which law enforcement entity should receive reports. DADS also recommends that owners, operators, employees, managers, agents or contractors of facilities and agencies review the Texas Penal Code, in particular the offenses in Chapters 22 (Assaultive Offenses), 31 (Theft) and 32 (Fraud). The Texas Penal Code is available on the Texas Legislature’s website at http://www.statutes.legis.state.tx.us/. Incidents of abuse, neglect and exploitation reported to law enforcement may result in a criminal investigation for one or more of the offenses in Chapters 22, 31 or 32.

Assistant Living Facilities:

The legislature has made changes to the process of removing an inappropriately placed resident. An excerpt:

An inappropriately placed resident is a resident who was appropriate when admitted to the ALF, but whose condition has changed. All residents must be appropriate for the ALF licensure type when admitted to the facility. After admission, if the resident’s condition changes, the resident may no longer be appropriate for the facility’s license. An ALF is not required to keep a resident who is no longer appropriate for the facility’s license. DADS proposes rule amendments to require facilities to include information about the facility’s policies and procedures for aging in place in their disclosure statement.

All ICF/ID with capacity of 13 or fewer beds:

Unless an ICF/ID provider is enrolled in the pilot program, an LVN may not provide on-call services. (Letter)

All Community Services 1915(c) Waiver providers:

Effective January 1, 2012, Medicaid 1915(c) waiver services recipients enrolled in a Medicare Part D prescription drug plan will no longer have to pay for Part D prescription co-payments. (Letter)

Public Notices

HHSC adopted a new per diem payment rate for the Tyler state-owned veterans nursing facility: $237.00. HHSC intends to submit to CMS a request to amend the Youth Empowerment Services waiver to expand the geographical area of the waiver to include Tarrant County in addition to Bexar and Travis Counties. See the Texas Register for more information.

Proposed Rules

HHCS proposes to amend §355.105, General Reporting and Documentation Requirements, Methods, and Procedures; §355.112, Attendant Compensation Rate Enhancement; §355.308, concerning Direct Care Staff Rate Component; §355.503, Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs; §355.505, Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program; and §355.5902, Reimbursement Methodology for Primary Home Care.

The proposed changes would:

1) formalize certain existing practices; 2) clarify due dates for consolidated cost reports; 3) change how entities request that their cost reports be aggregated for purposes of determining compliance with Attendant Compensation Rate Enhancement (the Enhancement) spending requirements; 4) eliminate the requirement that all contracts in an aggregated group participate in the Enhancement at the same level; and 5) allow providers subject to a recoupment for failure to meet Enhancement spending requirements on a specific Attendant Compensation Report, and providers subject to recoupment for failure to meet Direct Care Staff Rate staffing and/or spending requirements on a specific Staffing and Compensation Report, to, in certain situations, request that HHSC recalculate their recoupment after combining that report with the provider’s next cost report or Attendant Compensation or Staffing and Compensation Report, as appropriate.

The Texas Medical Board proposes to amend §185.4, Procedural Rules for Licensure Applicants, which  provides grounds for the extension of licensure applications that have been on file with the Board for over one year and allow for an alternative licensure process for military spouses. See the Texas Register for details.

Withdrawn Rules

HHSC withdrew the proposed repeal of 1 TAC §355.8381, Case Management Reimbursement Methodology, which appeared in the June 24, 2011, issue of the Texas Register (36 TexReg 3771).

Adopted Rules

The Board of Nursing adopted amendments to §217.6, Failure to Renew License, which are necessary to implement the requirements of SB1733, enacted by the 82nd Legislature, Regular Session, effective June 17, 2011, which simplifies to licensure process for military spouse applicants without compromising the safety of the public. An excerpt:

First, the Board has determined that military spouse applicants should not be required to pay the late fees and fines normally required for reactivating an expired or delinquent license. Because military spouses are often transferred from state to state with little notice, the Board has determined that the purpose of the late fees and fines, which is to encourage a licensee’s timely renewal, is not applicable in such situations. As such, the adopted amendments exempt military spouse applicants from paying these late fees and fines. However, only those military spouse applicants who submit a reactivation application to the Board in paper form will be exempt from paying these late fees and fines. This is because the Board’s online system is unable to process applications that are not accompanied by full payment of the late fees and fines normally required for the reactivation of an expired or delinquent license. Because the Board is unable to alter its online system at this time, the adopted amendments specifically require the reactivation application to be submitted in paper form in order for a military spouse applicant to receive this exemption.

• On DADS’ Behalf

Each change in the sections below authorizes DADS to deny or refuse to renew a license if an applicant or certain persons associated with an applicant are listed in a health and human service agency’s record of adverse licensing action maintained in accordance with Texas Government Code §531.952.

• Nursing Facility Requirements For Licensure And Medicaid Certification
• Intermediate Care Facilities For Persons With Mental Retardation Or Related Conditions
• Licensing Standards For Assisted Living Facilities
• Licensing Standards For Home And Community Support Services Agencies
• Adult Day Care And Day Activity And Health Services Requirements
• Denial Or Refusal Of License

Rule Review

The Texas Medical Board proposes to review Chapter 185, Physician Assistants, §§185.1 – 185.27, pursuant to the Texas Government Code, §2001.039.  Elsewhere in this issue. the Texas Medical Board contemporaneously proposes amendments to §185.4.

Proposed Rules

HHSC proposed new §351.507, adverse licensing, listing, or registration decisions by HHS agencies, in Chapter 351, Coordinated Planning and Delivery of Health and Human Services. The changes would permit agencies that license or regulate certain specified entities to consider adverse licensing decisions made by other HHS licensing agencies when considering a license application or renewal filed with that agency by another agency’s licensees. See the Texas Register for more information.

Adopted Rules

HHSC adopted amendments to §354.1041, Benefits for Medicare/Medicaid Recipients; §354.1143, Coordination of Title XIX with Parts A and B of Title XVIII; and §354.1149, Exclusions and Limitations. The new rules align Medicaid policies on cost sharing payments and limit Medicare Part B payments for services dual eligibles to no more than the Medicaid payment amount for the same service, with the exception of renal dialysis services. For details, see the Texas Register.

• On DADS’ Behalf

State Mental Retardation Authority Responsibilities – HHSC adopted the repeal of Subchapter I, In-Home and Family Support Mental Retardation Program, in Chapter 1, State Mental Retardation Authority Responsibilities, to remove those rules.

Mental Retardation Authority Responsibilities – HHSC adopted an amendment to §2.315, MRA administrative functions, in Chapter 2, Mental Retardation Authority Responsibilities, to remove the requirement that a MRA administer the In-Home and Family Support Program–Mental Retardation in its local service area.

Licensing Standards For Assisted Living Facilities – HHSC adopted an amendment to §92.2, concerning definitions, in Chapter 92, Licensing Standards for Assisted Living Facilities, to revise the definition of a “controlling person.”

Public Notice

HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance to update the current plan with recent fee schedule updates, including fees for new services and modified fees for existing services. See the Texas Register for more information.

Withdrawn Rules

The Texas Medical Board has withdraw the proposed amendment to §177.5, which appeared in the September 30, 2011, issue of the Texas Register (36 TexReg 6416).

Adopted Rules

The Texas Medical Board adopted amendments to §§177.12 and new §§177.14 – 177.17, Business Organizations. Among other things, the changes permit the board to assess administrative penalties against nonprofit health organizations that operate in conflict with the law and determine that the rule is consistent with statute.

The board also adopted amendments to §§187.2, 187.9, 187.13, 187.14, 187.16, 187.18 – 187.20, 187.24, 187.37, 187.38, 187.43, 187.55 – 187.58, 187.61, 187.62 and 187.83, Procedural Rules. Among other things, the changes amend the definition of “petition” to include appeals by applicants for licensure and adds a definition for “remedial plan.”

For more information about all changes, see the Texas Register.

Public Notices

HHSC intends to submit to CMS a request to amend the Non-Emergency Medical Transportation waiver program, which would add Colorado, Erath, Palo Pinto, and Somerville counties to the waiver to realign the counties in the full-risk broker model areas that impact the waiver. Jasper, Newton, Polk, San Jacinto, and Tyler counties will be removed.

Adopted reimbursement rates for large, state-operated ICFs/MR and for small, state-operated ICFs/MR: $582.57 and $562.13. See the Texas Register for more information about both notices.

Proposed Rules

The Texas Board of Nursing proposed to amend §217.6, Failure to Renew License, which would simplify the licensure process for military spouse applicants without compromising the safety of the public. An excerpt:

First, the Board has determined that military spouse applicants should not be required to pay the late fees and fines normally required for reactivating an expired or delinquent license. Because military spouses are often transferred from state to state with little notice, the Board has determined that the purpose of the late fees and fines, which is to encourage a licensee’s timely renewal, is not applicable in such situations. As such, the proposal exempts military spouse applicants from paying these late fees and fines. However, only those military spouse applicants who submit a reactivation application to the Board in paper form will be exempt from paying these late fees and fines. This is because the Board’s online system is unable to process applications that are not accompanied by full payment of the late fees and fines normally required for the reactivation of an expired or delinquent license. Because the Board is unable to alter its online system at this time, the proposed amendments specifically require the reactivation application to be submitted in paper form in order for a military spouse applicant to receive this exemption.

Second, in compliance with the provisions of SB 1733, the Board has determined that military spouse applicants who have practiced nursing in another jurisdiction within the four years immediately preceding a reactivation application are exempt from completing 20 contact hours of continuing education. This exemption not only allows these applicants to demonstrate their competency to practice through alternative means, as mandated by SB 1733, but it also protects the health and safety of the public by ensuring that an applicant has recently practiced nursing in another jurisdiction and is a safe and competent practitioner.

Withdrawn Rules

The Texas Medical Board has withdrawn the proposed amendments to §192.1 and §192.2, and new §§198.1 – 198.3. See the Texas Register for details.

Adopted Rules

The Texas Medical Board adopted changes to several sections of the code:

• Licensure
• Reinstatement And Reissuance
• Temporary And Limited Licenses
• Fees And Penalties
• Complaints
• Surgical Assistants
• Pain Management Clinics

On DADS’ behalf, HHSC adopted changes to several sections of the code:

• Mental Retardation Services–Medicaid State Operating Agency Responsibilities
• Nursing Facility Administrators
• Community Living Assistance And Support Services
• Community Care For Aged And Disabled
• Medically Dependent Children Program
• Nurse Aides
• Medication Aides–Program Requirements

Rule Review

The Texas Medical Board adopted the review of  Chapter 163, Licensure, §§163.1, 163.2, 163.4 – 163.11 and 163.13, and adopted amendments to §§163.1, 163.2, 163.6, 163.7 and 163.11.

The board also adopted the review of Chapter 167, Reinstatement and Reissuance, §§167.1 – 167.8, pursuant to the Texas Government Code, §2001.039 and adopted amendments to §167.8. For details, see the Texas Register.

• Anonymous complaints: The TMB will no longer accept anonymous complaints. “Anonymous” is defined as a complaint that “lacks sufficient information to identify the source or the name of the person who filed the complaint.” That is, the TMB has to be able to identify the complainant. However, the TMB does not have to inform the physician of the name of the person making the complaint, with one exception. If the complainant is an insurance agent, insurer, pharmaceutical company, or third-party administrator, the TMB will notify the physician of the name and address of such party within 15 days after a complaint is filed, unless the notice would jeopardize an investigation.
• Seven year statute of limitations on patient care complaints: The TMB can no longer consider a complaint that is based on care that was provided more than seven years prior to the TMB receiving the complaint, unless the care was provided to a minor. If the care involved a minor patient, the statute of limitations is the later of (a) the date the minor becomes 21 years of age, or (b) the seventh anniversary of the date of care.
• Recording ISC proceedings: Physicians taking part in an Informal Settlement Conference (“ISC”) with the TMB may now request that the proceedings be recorded. The recording becomes part of the TMB file and is confidential.
• Deference to SOAH: After a contested case is heard at the State Office of Administrative Hearings (“SOAH”), the TMB must issue a final Order adopting the findings of fact and conclusions of law reached by the SOAH administrative law judge. However, the TMB retains the discretion as to determining the appropriate action or sanction against the physician.
• Extended timeframes for TMB to complete preliminary investigation: The timeline for the TMB has to complete a preliminary investigation of a complaint and notify a physician of an ISC was changed from 30 to 45 days.
• Remedial plans: The TMB may institute a “remedial plan” to resolve the investigation of a complaint. This plan may not contain a condition that either revokes, suspends, limits or restricts a physician’s license or other authorization to practice medicine or assess an administrative penalty against a physician. However, the TMB may charge the physician for administering the plan. A remedial plan may not be imposed to resolve complaints concerning: 1) a patient’s death; 2) the commission of a felony; 3) a matter where the physician engaged in inappropriate sexual behavior or contact with a patient or became financially or personally involved in an inappropriate manner with a patient; or 4) a matter in which the appropriate resolution may involve a restriction on the manner in which a license holder practices medicine. The physician may not have previously entered into a remedial plan for a different complaint, and the remedial plan becomes public information.

As noted above, the provisions of HB 680 are effective September 1, 2011. The new provisions do not contain any language indicating that the provisions are retroactive. Courts generally presume that the Legislature intends a statute or amendment to operate prospectively and not retroactively. However, this general rule does not apply when the procedural, so the rules above may well apply to proceedings pending as of September 1, 2011.

The version of the law that became effective was not as far-reaching as the originally proposed bill (House Bill 1013). House Bill 1013 would have eliminated “confidential” complaints, rather than just anonymous complaints. That is, the TMB would have had to provide physicians with the name of an individual filing a complaint, unless the complainant was a patient or patient’s family member. House Bill 1013 contained several other provisions that would have been helpful to provisions but were not signed into law, such as:

• Mandating that the TMB may only use actively practicing physicians as experts, who review the record with the name of the accused physician withheld;
• Allowing a 45-day period for physicians to respond to complaints;
• Granting physicians a right to a jury trial if their license is revoked; and
• Requiring the TMB to annually disclose who participated on its ISC panels, and how often.

Public Notice

HHSC issued an amended public notice of intent to seek a waiver from CMS to expand the STAR+PLUS program. An excerpt:

The waiver request, in its final form, is now available to the public, as described below. HHSC is publishing this amended notice to alert interested parties that the comment period will remain open to take comments on the waiver request until 5:00 p.m., August 31, 2011.

The waivers relate to the transition of all current STAR and STAR+PLUS areas, the inclusion of 28 additional counties effective September 1, 2011, and the phase-in of more counties effective March 1, 2012. The counties are listed in the table below.

The waiver request would allow expansion of Medicaid managed care throughout Texas by maintaining historic local contributions to Medicaid for hospitals currently receiving upper payment limit payments. If approved, acute care benefits will be administered statewide through managed care. Other Medicaid services and long-term services and supports will be available in specific counties.

Proposed Rules

HHSC proposes new Division 27 in Chapter 354, Subchapter A, §§354.1361 – 354.1364, Women’s Health Program (WHP). Among other things, the changes would restrict applicability of the proposed new division to the WHP and define the terms “affiliate,” “corporate entity,” “elective abortion,” “health clinic,” “HHSC,” “promotes,” and “Women’s Health Program.” See the Texas Register for details.

• On DADS’s Behalf

HHSC proposes to repeal Subchapter C, §§8.51 – 8.63, Life-Sustaining Treatment, in Chapter 8, Client Care–Mental Retardation Services, to remove rules regarding life-sustaining treatment in state supported living centers.

HHSC proposes new §9.229, concerning critical incident reporting, and amendments to §9.238, concerning level of care I criteria, and §9.239, concerning ICF/MR level of care VIII criteria, in Chapter 9, Mental Retardation Services–Medicaid State Operating Agency Responsibilities, Subchapter E, ICF/MR Programs–Contracting. The changes would require ICF/MR providers to report data related to critical incidents, which would help DADS report certain information to HHSC annually.

HHSC proposes to amend §49.1, concerning definitions, in Subchapter A, Definitions; an amendment to §49.12, concerning general requirements for participation, and the repeal of §49.19, concerning advertising and solicitation of clients, in Subchapter B, Contractor Requirements; and an amendment to §49.61, concerning sanctions, in Subchapter F, Sanctions and Terminations, in Chapter 49, Contracting for Community Care Services, which would remove references to solicitation from Chapter 49 and update references to Texas Department of Human Services to reflect agency name changes to DADS.

For more information about each rule proposed on DADS’ behalf, see the Texas Register.

Withdrawn Rules

HHSC has withdrawn proposed amendments to §§48.6002, 48.6040, 48.6050, and 48.6078 which appeared in the July 1, 2011, issue of the Texas Register (36 TexReg 4098).

Adopted Rules

HHSC adopted amendments to §355.723, Reimbursement Methodology for HSC and TxHmL programs, which establishes the reimbursement methodology.

HHSC adopted amendments to §355.7103, Rate-Setting Methodology for 24-Hour Residential Child-Care Reimbursements, to delete the rate end date currently in the rule.

HHSC adopted the repeal of §355.8052, Medicaid Inpatient Hospital Reimbursement; and adopted new §355.8052, Medicaid Inpatient Hospital Reimbursement, which describes the new prospective payment system applicable to Medicaid inpatient hospital payments.

HHSC adopted new §355.8055, Reimbursement Methodology for Rural and Certain Other Hospitals, which describes the Medicaid methodology for reimbursing rural hospitals, rural referral centers, sole community hospitals, and critical access hospitals.

HHSC adopted an amendments to §355.8061, Payment for Hospital Services, to reorganize and clarify subsection (a)(2) and to change Medicaid payment methodology in two areas: (1) non-emergency services provided in an emergency department (ED); and (2) imaging services.

HHSC adopted amendments to §355.8551, concerning the dispensing fee for Medicaid pharmacy services reimbursement, to remove the reimbursement rate component fee amounts for the pharmacy dispensing fee, clarify terms in the dispensing fee formula, and add definitions for the components of the formula.

HHSC adopted the repeal of §370.47, State Kids Insurance Program (SKIP) to abolish it and allow children of qualifying state employees to enroll in the Children’s Health Insurance Program.

Finally, HHSC adopted amendments to §372.956, concerning the expedited Supplemental Nutrition Assistance Program (SNAP) application process; and the repeals of §§372.1201 – 372.1204, concerning finger-imaging requirements. The changes remove references to the finger-imaging requirement for Temporary Assistance to Needy Families and SNAP households from HHSC’s rule base in compliance with recent legislative direction.

For more information on each adopted rule, see the Texas Register.

• On DADS’s Behalf

HHSC adopted an amendment to §48.6026, in Chapter 48, Community Care for Aged and Disabled, to require an HCSSA contracting with DADS to provide CBA services to maintain licensure in the licensed home health services category and permit the provider to maintain licensure in the personal assistance services category to provide CBA personal care tasks that do not require nurse delegation or supervision, including the assignment of health maintenance activities. See the Texas Register for details

Public Notice

HHSC intends to submit Amendment 28 to the Texas State Plan for the Children’s Health Insurance Program (CHIP) to ensure that Texas CHIP dental coverage includes dental benefits from each of the required categories of care. See the Texas Register for details.

Adopted Rules

The Texas Board of Nursing adopted new §217.21, Remedial Education Course Providers and Remedial Education Courses, with changes to the proposed text published in the May 27, 2011, issue of the Texas Register. An excerpt:

The Board formally proposed new §217.21 in the May 27, 2011, issue of the Texas Register (36 TexReg 3244). A public hearing on the rule proposal was held on June 29, 2011. In response to written comments on the published proposal and comments received during the public hearing, the Board has changed some of the proposed language in the text of the rule as adopted. The changes, however, do not materially alter issues raised in the proposal, introduce new subject matter, or affect persons other than those previously on notice.

The Board has made changes to §217.21(d)(2)(B), (D), and (E) as adopted in response to comments that the proposed rule was too limiting and would prohibit potentially qualified remedial education course instructors (instructors) from teaching certain remedial education courses (courses). The proposed rule required all instructors to hold a master’s degree in nursing from an approved or accredited institution and to have a minimum of five years of professional nursing experience. A commenter representing an organization pointed out that these requirements would unnecessarily prohibit individuals holding other advanced academic degrees from teaching courses in their fields of expertise. The commenter went on to state that such individuals possess specific knowledge that would be beneficial to a nurse attending a course and that this knowledge may not be possessed by a master’s prepared nurse without the same credentials or experience.

The board adopted amendments to §223.1, Fees, which are necessary to establish new fees for the approval and renewal of remedial education courses. ($300 for the initial approval of a remedial education course and a $100 for the renewal) For more information, see the Texas Register.

Public Notices

HHSC adopted new per diem payment rate for the Truman Smith Children’s Care Center, which is $223.44. HHSC adopted new per diem payment rates for state-owned veterans nursing facilities: Big Spring, $143; Bonham, $143; Floresville, $143; Temple, $143; McAllen, $143; El Paso, $143; and Amarillo, $143.

Finally, HHSC intends to submit to CMS a request to amend the MDCP waiver program. The change would adjust the individual cost limit to ensure that no one loses eligibility. For details about each notice, see the Texas Register.

Proposed Rule

HHSC proposes to amend §360.117, concerning cost sharing in the Medicaid Buy-In program, to exempt adults enrolled in the program who live in a federally declared disaster area from paying premiums for up to three months beginning with the month that the disaster is declared. See the Texas Register for more information.

Adopted Rules

HHSC adopted amendments to §355.101, Introduction; §355.102, General Principles of Allowable and Unallowable Costs; §355.103, Specifications for Allowable and Unallowable Costs; §355.105, General Reporting and Documentation Requirements, Methods, and Procedures; §355.106, Basic Objectives and Criteria for Audit and Desk Review of Cost Reports; §355.107, Notification of Exclusions and Adjustments; and §355.110, Informal Reviews and Formal Appeals, in its Reimbursement Rates chapter. An excerpt:

HHSC, under its authority and responsibility to administer and implement rates, is updating Subchapter A to: 1) incorporate the School Health and Related Services program; 2) accommodate the utilization of a web-based cost reporting system; 3) formalize certain existing practices; 4) standardize the cost at which a purchase must be depreciated; 5) allow for the reporting of certain costs associated with workers’ compensation; and 6) specify the repercussions of submitting an incomplete request for an informal review.

On DADS’s behalf, HHSC proposed amendments to the following sections:

• Nursing Facility Requirements For Licensure And Medicaid Certification – (“References to a pediatric nurse specialist have been deleted because DADS no longer employs such a specialist.”)

• State Aging Plan – (Repeal “adopted because a new section that contains the funding allocation formula for area agencies on aging is adopted elsewhere in this issue of the Texas Register.”)

• Operation Of The Area Agencies On Aging –(Repeal “adopted to remove the rule regarding the process by which a person contracting with an AAA, a subcontractor, appeals an adverse action taken by the AAA against the subcontractor.” )

• State Delivery Systems – (Repeal “adopted because a new section that contains the guidelines to determine the proportion of state money distributed to entities that operate a program under the National Senior Services Corps is adopted elsewhere in this issue of the Texas Register.”)

• Area Agency On Aging Administrative Requirements – (Repeal “adopted because a new section that describes how award funds not spent by an [AAA] are handled and a new section that describes the process for a AAA to request approval to directly provide a service are adopted elsewhere in this issue of the Texas Register.”)

• Implementation Of The Older Americans Act -  (“The new sections and amendment prescribe administrative responsibilities of an [AAA]  regarding the provision of services and describe the management and oversight functions of DADS regarding AAAs.”)

• National Senior Services Corps Program – (“The new section describes the guidelines used to determine the proportion of state money distributed to entities operating a program under the National Senior Services Corps…” )

• Miscellaneous – (Repeal “adopted to allow DADS the flexibility to develop procedures based on communication technology and other factors at the time a hearing is held.”)